A 39-year-old woman who developed acute left-sided facial paralysis (“Bell’s Palsy”) four days after contracting a COVID-19 infection was successfully managed using a Wind-dispersing herbal strategy combined with acupuncture and cervical spinal adjustment.

Case ID: CHC-0069

Case Summary

This case describes a 39-year-old woman who presented with acute left-sided facial paralysis, characterized by an inability to close her left eye and a rightward deviation of her mouth, triggered immediately following a COVID-19 infection. The original report documented a conventional diagnosis of peripheral facial nerve paralysis complicating a novel coronavirus infection, and a TCM assessment of Facial Paralysis (Mian Tan) driven by Wind-Cold Epidemic Toxin. She was managed through a highly integrative approach combining “Zhao’s Balanced Spinal Adjustment” to relieve localized cervical nerve tension, targeted facial acupuncture, and a phased herbal strategy transitioning from aggressively expelling cold (Mahuang Fuzi Xixin Tang) to deeply tonifying Qi and Blood (Bazhen Tang).

Patient Presentation

• Patient: 39-year-old female (Surname: Chen).
• Main Complaint: Inability to close the left eye accompanied by rightward deviation of the mouth corner for 4 days.
• History: The patient sought initial consultation on March 11, 2023. Four days prior, she contracted COVID-19, experiencing a sore throat, low-grade fever, mild cough, systemic muscle and joint aches, and poor appetite. Upon waking with a headache, she discovered her left eye would not close completely and her mouth was crooked to the right, causing water to leak when she rinsed or drank. She had a notable prior history of right-sided facial paralysis in June 2022, which was successfully treated at the same hospital.
• Physical Exam: The left facial muscles were paralyzed with a loss of forehead wrinkles. The left eye had a 0.3cm gap when attempting to close, and the left nasolabial fold was shallow. The cheek puff, teeth-showing, and brow-raising tests were all positive (+) for weakness. Crucially, palpation revealed tense neck muscles with a localized nodule and spasm near the C1-C2 (Yifeng acupoint) area and distinct tenderness near the C3 transverse process.

Examination and Diagnosis

• Conventional Diagnosis: Peripheral facial nerve paralysis complicating novel coronavirus infection.
• TCM Tongue and Pulse: The tongue was pale red with a thin, white coating. The pulse was stringy and fine (脉弦细).

TCM Assessment

The original practitioner interpreted the presentation as Facial Paralysis driven by Wind-Cold Epidemic Toxin (面瘫 – 风寒疫毒型).

According to the holistic principles of yin and yang Chinese Medicine an acute viral infection like COVID-19 severely depletes the body’s Righteous Qi (Zheng Qi) and leaves the protective exterior empty. Because her defensive barrier was weakened, the epidemic Wind-Cold pathogen invaded her facial meridians.

This pathogen caused the localized Qi and blood to stagnate, preventing the facial sinews from receiving nourishment and causing them to lose their mechanical restraint (resulting in the paralysis). Furthermore, the viral pathogen severely aggravated the muscles of her upper cervical spine (C1-C3), causing structural spasms that further blocked the blood supply to her head and face. The pale red tongue and stringy-fine pulse provided objective confirmation of this combination of underlying deficiency and acute pathogenic blockage.

Treatment Approach

The primary treatment principle was to dispel wind and scatter cold, resolve toxicity and reduce swelling, unblock collaterals and stop spasms (祛风散寒，解毒消肿，通络止痉). The strategy heavily integrated mechanical relief (adjusting the neck to restore blood flow) with chemical relief (using herbs and acupuncture to fight the virus and stimulate the facial nerves).

Interventions and Herbal Formulas

• Zhao’s Balanced Spinal Adjustment (Manipulative Therapy):
  • The practitioner applied manual spinal adjustments to restore cervical balance. By specifically targeting the C1-C3 spasms, this mechanical release eased the vertebral artery spasms, broke up soft tissue adhesions, and immediately improved the micro-circulation and oxygen supply to the paralyzed half of the face.
• Acupuncture & Tuina Therapy:
  • Acupuncture: Points included Fengchi (GB20), Hegu (LI4), Shuigou (GV26), Chengjiang (CV24), and Yintang (EX-HN3). Left-sided facial points included Cuanzhu (BL2), Dicang (ST4), Yangbai (GB14), Chengqi (ST1), Yingxiang (LI20), and Jiache (ST6). A “mild reinforcing and heavy reducing” technique was used, retaining needles for 30 minutes alongside infrared heat therapy.
  • Tuina: Targeted facial acupressure was used to manually unblock the meridians and stimulate the impaired muscles.
• Initial Herbal Formula (Acute Phase – March 11, 2023): A 13-herb decoction acting as a modified Mahuang Fuzi Xixin Tang to aggressively push out the cold-toxin.
  • Xi Xin (6g), Fu Pian (Prepared Aconite, 5g), and Gui Zhi (12g) powerfully warmed the interior and scattered the deep, freezing wind-cold from the meridians.
  • Lian Qiao (10g) and Pu Gong Ying (Dandelion, 15g) specifically cleared the viral heat and toxicity. Chuan Xiong (12g), Chi Shao (12g), and Bai Zhi (6g) drove the medicinal effects directly to the head to move blood and stop the headache. (3 doses).
• Second Visit (March 18, 2023): The eye closure and mouth deviation improved. As the cold pathogen transformed into heat (tongue tip turned red with a yellow coating), the formula was dynamically adjusted to nourish Yin and clear heat, utilizing Sheng Di Huang (30g), Dan Shen (10g), and insect medicinals like Wu Gong (Centipede, 2g) and Quan Xie (Scorpion, 6g) to forcefully unblock the facial nerves.
• Third Visit (Recovery Phase – March 29, 2023): The patient was largely recovered and discharged to outpatient care. The treatment principle shifted to tonifying Qi and Blood to prevent relapse. A modified combination of Bazhen Tang (Eight-Treasure Decoction) and Qianzheng San (Lead to Symmetry Powder) was prescribed: Dang Shen (15g), Bai Zhu (15g), Huang Qi (15g), Dang Gui (10g), Jiang Can (Silkworm, 10g), and Tian Ma (10g) to rebuild her immune system and consolidate the cure. (5 doses).

Follow-Up

• After six total outpatient treatments continuing into April 2023, the patient’s symptoms completely disappeared, and she achieved a full clinical recovery. She was advised to avoid wind exposure, wear masks/eyepatches outdoors, and practice Ba Duan Jin qigong to maintain her immunity.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the recognition of upper cervical spine dysfunction as a major aggravating factor in post-viral Bell’s Palsy.

While conventional treatments (steroids, antivirals) and standard TCM treatments (acupuncture, Qianzheng San) focus entirely on the face, Professor Zhao’s physical examination revealed severe structural spasms at C1-C3 (near the Yifeng acupoint). Because the blood vessels and nerves supplying the face pass through this area, viral inflammation in these neck muscles acts like a “kinked hose,” starving the facial nerves of oxygen and preventing recovery. By integrating manual bone-setting to unkink the neck, alongside the classic viral-fighting Mahuang Fuzi Xixin Tang, the practitioner achieved a rapid and comprehensive reversal of the paralysis in just a few weeks.

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Source Original source: Zhanjiang Second Hospital of Traditional Chinese Medicine Original title: 【以案说医】招仕富：治疗新冠病毒感染并发面瘫案（二） Practitioner: Professor Zhao Shifu (招仕富) Publication date: August 25, 2024 Original language: Chinese ChineseHerb.org version: English translation and editorial adaptation